Commonwealth of Massachusetts
Executive Offices of Health and Human Services
Chapter 257 of the Acts of 2008 
Provider Information Gathering Session:
Community Based Flexible Supports
September 30, 2013 
www.mass.gov/hhs/chapter257 
eohhspospolicyoffice@state.ma.us 

Agenda
•	Chapter 257 of the Acts of 2008
•	Review of Pricing Analysis and Methodologies
•	Community Based Flexible Supports (CBFS) proposed timeframe
•	Stakeholder Discussion
•	Encounter Survey Updates
•	Housing Survey Updates
•	Regional Dialogue Session Summary
•	Timeline and Key Milestones
•	Next Steps

Chapter 257 of the Acts of 2008 Regulates Pricing for the POS System
Community Based Flexible Supports
Proposed Timeline
•	May 2013
o	Survey Results; Contract Data
•	Summer 2013
o	Model Development
o	Rate considerations
o	Input and Questions
•	Fall 2013
o	Regional Dialogues
o	Incorporating Stakeholder Input
•	Fall 2013
o	Rates shared with public

Winter 2013-14

Winter 2014 
Community Based Flexible Supports: 
Encounter Survey - Background

•	Goal: To gather information of the number and types of clients in CBFS received over a two week period.
•	Data was reported on encounters on Rehab, Support & Supervision.
•	Failed encounters were also captured.

•	Data Validation Process: 100% of CBFS providers responded to the survey.
•	Data was reported on 11,507 clients (over 95%).

In the presentation there is a graph that represents the Total Number of Encounters Per Client by Living Arrangement. Data is also represented in the chart below:

Encounters Per Client by Living Arrangement	
 	Staffed Setting	%	Non Staffed Setting 	%	Total	%	
0 Encounters	36	1%	766	9%	802	7%	
1-15 Encounters	358	14%	6,245	72%	6,603	59%	
16-30 Encounters	261	10%	934	11%	1,195	11%	
31+ Encounters	1,984	75%	676	8%	2,660	24%	
Total	2,639	100%	8,621	100%	11,260	100%	

In the presentation there is a graph that represents the Rehab Number of Encounters Per Client by Living Arrangement. Data is also represented in the chart below:

Rehab Encounters Per Client by Living Arrangement	
 	Staffed Setting	%	Non Staffed Setting 	%	Total	%	
0 Encounters	181	7%	2,035	24%	2,216	20%	
1-15 Encounters	1,401	53%	6,286	73%	7,687	68%	
16-30 Encounters	501	19%	212	2%	713	6%	
31+ Encounters	556	21%	88	1%	644	6%	
Total	2,639	100%	8,621	100%	11,260	100%	

In the presentation there is a graph that represents the Supervision Encounters Per Client by Living Arrangement. Data is also represented in the chart below:
Supervision Encounters Per Client by Living Arrangement	
 	Staffed Setting	%	Non Staffed Setting 	%	Total	%	
0 Encounters	506	19%	7,032	82%	7,538	67%	
1-15 Encounters	837	32%	1,455	17%	2,292	20%	
16-30 Encounters	450	17%	67	1%	517	5%	
31+ Encounters	846	32%	67	1%	913	8%	
Total	2,639	100%	8,621	100%	11,260	100%	

In the presentation there is a graph that represents the Supervision Encounters Per Client by Living Arrangement. Data is also represented in the chart below:

Support Encounters Per Client by Living Arrangement	
 	Staffed Setting	%	Non Staffed Setting 	%	Total	%	
0 Encounters	71	3%	1,700	20%	1,771	16%	
1-15 Encounters	651	25%	6,001	70%	6,652	59%	
16-30 Encounters	500	19%	571	7%	1,071	10%	
31+ Encounters	1,417	54%	349	4%	1,766	16%	
Total	2,639	100%	8,621	100%	11,260	100%	

In the presentation there is a graph that represents the Number of Encounters on Homeless Client by Type of Encounter received. Data is also represented in the chart below:
Homeless	Rehab	Supervision	Support	
0 Encounters	101	34%	246	84%	58	20%	
1-15 Encounters	189	65%	38	13%	208	71%	
16-30 Encounters	3	1%	5	2%	16	5%	
31+ Encounters	0	0%	4	1%	11	4%	
Total	293	 	293	 	293	 	

In the presentation there is a graph that represents the Percent of Clients with Failed Encounters by Living Arrangement. Data is also represented in the chart below:

Staffed Setting	17%	
Shared Apartment	20%	
Family Home	21%	
Individual Setting	17%	
Homeless	16%	
Institutional  Setting	11%	
Respite	24%	

Community Based Flexible Supports: Housing Survey Background

•	Goal: To gather FY2012 cost data on residential sites that provide CBFS services. 
•	Part A: FY 2012 expenses related to properties where providers have financially responsibility for the residential sites (owned or directly leased). 
•	Part B: FY 2012 expenses for CBFS participants who live in their own dwellings.
 
•	Data Validation Process: Total 19 providers (100%) responded to the survey. 
•	Part A: Total 404 site information, representing 2942 beds was analyzed. 
•	Part B:  Analysis was based on the aggregated expenditure for each provider. 

Community Based Flexible Supports: Housing Survey Review Elements

•	Total Unit Cost Analysis by: 
•	4 Geographic Regions
•	Ownership Status
•	Year Site Placed in Service
•	Mortgage Unit Cost 
•	Rent Unit Cost
•	Utilities Unit Cost
•	Offset Analysis

Community Based Flexible Supports: Housing Survey
In the presentation there is a graph that represents the Total Unit Cost Distribution Per Bed Per Day. Data is also represented in the chart below:

* The majority of the total unit cost falls within a range from $10 to $30 per day.
* Median: $19.67, Average: $21.32

In the presentation there is a graph that represents the Total Average Unit Cost by 4 Geographic Areas. (Per Bed Per Day) (Per Bed Per Day)
*The P Value is not below 0.05, thus the geographic variance is not a main cost driver.  
*Total W. Avg Unit Cost:  $19.94. 	
Geographic Area	# of Sites	Total # of Beds Per Day	Average Per site	
Central-West	101	644	6.4	
Metro Boston	98	1,023	10.4	
Northeast - Suburban	147	887	6.0	
Southeast	57	388	6.8	

In the presentation there is a graph that represents the Total Unit by Ownership Status. Data is also represented in the chart below:

DMH Own	11.17	
Provider Own	25.54	
Provider Leased	21.16	
Leased from Related Party	12.53	

In the presentation there is a pie chart that represents the Years of Site in Place of Service and a graph that shows the total average unit cost by year of site placed in service.

In the presentation there is a graph that shows the Rent Unit Cost Distribution. The Average Rent Unit Cost: $12.36
In the presentation there is a pie chart that represents the Rent Proportion Percent of the Total Unit Cost.
*The majority of the rent costs fall between 51% and 70% of the total unit cost. 
In the presentation there is a chart that represents the Utilities Unit Cost Distribution. Data is also represented in the chart below:
Utilities Unit Cost Range	# of Sites (Frequency) 	
4	60	
8	150	
12	121	
16	38	
20	19	
24	4	
28	3	

In the presentation there is a pie chart that represents the Type of Heat Used at the sites. Data is also represented in the chart below:
Type of Heat	# of Sites	
Other	1%	
Electric	4%	
Oil	27%	
Natural Gas	67%	

In the presentation there is a graph that represents the Offset Unit Cost Distribution and a pie chart which represents the proportion of offset by type of offset.
In the presentation there is a graph that represents the Average Offset Unit by region.

Community Based Flexible Supports: Regional Dialogues – Update
Regional Dialogues were held throughout the state and at varying times during the month of September.  The intent was to encourage input on CBFS core services and programs from CBFS clients and interested parties.

Some recurring themes heard at the meetings include:
•	Housing – need for affordable housing; maintain and expand service
•	Family Involvement – desired expressed for families to understand the services being provided, and the CBFS services available to them
•	Lack of consist job titles used between providers
•	Lack of consistent program design across providers – equity concerns
•	Need for peer support
•	Value of “hands on” help – grocery shopping, etc.
•	Employment Assistance – some overlap with other programs (e.g., Clubhouse)
•	Monitoring – some concerns expressed, but no alternative recommendations were offered

	
Community Based Flexible Supports:
Next Steps
Next Stakeholder and Provider Engagement Session to be held in October/November 2013.

Information will be posted on the C.257 website and CommPass as soon as a date has been established. 

This meeting presentation will be Posted on Chapter 257 website
Tuesday, October 1, 2013: www.mass.gov/hhs/chapter257  

Comments and questions regarding Chapter 257 process can be sent to: EOHHSPOSPolicyOffice@state.ma.us